For each round, the number of experts who completed the surveys will be documented. Definition of consensus For statements with responses on an ordinal 7-point Likert scale rating 1, strongly disagree to 7 strongly agree , 'agreement' will be defined as a score of , 'neutral' by a score of 4 and 'disagreement' by a score of If consensus is not reached for one question using Likert scale or MCQ after 3 rounds, dissensus is acted.
For this study, four rounds are planned, including round 1 with open-ended questions see below and a maximum of three rounds to obtain consensus. If you are interested in learning more about this trial, find the trial site nearest to your location and contact the site coordinator via email or phone. We also strongly recommend that you consult with your healthcare provider about the trials that may interest you and refer to our terms of service below.
The National Psoriasis Foundation NPF is a non-profit organization with a mission to drive efforts to cure psoriatic disease and improve the lives of those affected. Any duplication, rebroadcast, republication or other use of content appearing on this website is prohibited without written permission of National Psoriasis Foundation. The National Psoriasis Foundation does not endorse or accept any responsibility for the content of external websites. The National Psoriasis Foundation does not endorse any specific treatments or medications for psoriasis and psoriatic arthritis.
Login Become a Member. Have questions about psoriatic disease? Clinical Trial Finder. Search Results Systemic Treatment of Moderate-to-severe Psoriasis in Adults: Update of the French Guidelines Study Purpose French guidelines on the use of systemic treatments for moderate-to-severe psoriasis in adults have been developed by the psoriasis research group of the French Society of Dermatology using literature available until July Amatore et al, Recruitment Criteria Accepts Healthy Volunteers Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms.
Searching Both is inclusive of interventional and observational studies. Category of organization s involved as sponsor and collaborator supporting the trial. The disease, disorder, syndrome, illness, or injury that is being studied. Additional Details. Center of Evidence of Dermatology, Paris, France. Powered By. Menu Donate Register Search. Community icon:. Link text:. Get free, personalized guidance and support for psoriasis and psoriatic arthritis. Are you newly diagnosed? Have questions?
A new website for parents, kids and teens with psoriasis and psoriatic arthritis! Stay Informed icon:. Get the latest news on psoriasis and psoriatic arthritis. Learn from others journeying down the path to wellness. Of all the topical treatments available, corticosteroids have shown the greatest efficacy in clinical trials for scalp psoriasis, and are the most commonly prescribed treatment.
Several reports suggest that patients prefer newer cosmetically appealing options such as sprays and foams. Although some caution exists against prescribing potent topical corticosteroids for chronic use in scalp psoriasis, the scalp is relatively resistant to atrophy induced by these medications.
In randomized controlled trials, super-potent CP in various formulations has been shown to be the most efficacious topical treatment for scalp psoriasis. A recent Cochrane review found the most evidence for the use of CP in the treatment of scalp psoriasis, with four high-quality clinical trials demonstrating a combined 1.
In addition to sprays and shampoos, the foam or mousse vehicle has become popular with many patients. CP foam has also been found to be highly efficacious in the treatment of scalp psoriasis. One randomized, double-blind study in patients with moderate-to-severe scalp psoriasis compared the use of CP foam 0.
In this study, the PASI score dropped from 5. Although there are fewer trials to support their benefit, other very potent topical corticosteroids eg, betamethasone dipropionate and medium to potent topical corticosteroids eg, betamethasone valerate [BMV] were reported to have a similar beneficial effect to CP.
Eighty-eight percent of patients using BMV 0. Vitamin D analogs have been shown to induce dose-dependent anti-proliferative and pro-differentiating effects in the epidermal keratinocytes of psoriatic skin.
The efficacy and long-term safety of calcipotriol has been evaluated in a number of studies. Studies directly comparing the effects of vitamin D analog monotherapy with very potent or potent steroid monotherapy consistently demonstrate the superiority of corticosteroids for the treatment of scalp psoriasis.
A combination product containing calcipotriol 0. This combination foam product has been proven to be both safe and effective for body psoriasis and currently studies are underway in scalp psoriasis. Intralesional corticosteroids have been applied in practice, although specific studies evaluating the effects of this treatment regimen on scalp psoriasis are lacking.
Anecdotal reports of their use exist, and in , the US National Psoriasis Foundation recommended intralesional corticosteroids as second-line treatment for scalp psoriasis. Scalp psoriasis is not typically treated with systemic therapy unless it is required for recalcitrant or severe cases. Although evidence is lacking for conventional agents such as acitretin, methotrexate, and cyclosporine, a few clinical trials looking at the response of scalp psoriasis to biologic therapy and newer agents have been reported, either as sub-analyses or prespecified end points.
Overall, scalp psoriasis does improve in conjunction with improvement of body psoriasis with all systemic therapies. Apremilast, an oral PDE4 inhibitor, has been studied in three Phase 3 studies. The study design included a week placebo-controlled period in which patients were randomized to apremilast 30 mg twice daily or placebo.
At 16 weeks, the percentage of patients who achieved an ScPGA score of 0 clear or 1 minimal was significantly greater in the apremilast group In those patients who received apremilast from baseline, Of the patients initially randomized to placebo who switched to apremilast at week 16, The anti-TNF receptor fusion protein, etanercept, has the most clinical trial data supporting its use in scalp psoriasis.
Etanercept was given in an open-label trial of 2, patients to compare continuous versus interrupted therapy. All patients continuous therapy and interrupted therapy groups were treated with etanercept 50 mg twice weekly for the first 12 weeks of the study.
After 12 weeks of etanercept 50 mg twice weekly, the continuous and interrupted groups achieved a mean percentage improvement from baseline in Psoriasis Scalp Scores of Up to week 24, after the continuous therapy group remained on 50 mg once weekly, the mean percentage improvement from baseline scalp score was maintained at Also reported is a randomized, placebo-controlled trial assessing the safety and efficacy of etanercept for scalp psoriasis over a week period. The primary end point was percentage change in PSSI at week There was also improvement noted in scalp surface area involvement, with a mean percentage improvement at week 12 in Group A of At week 24, Group A maintained this benefit at Changes in overall PASI improvement were consistent with the PSSI improvements and time to improvement was similar; treatment also provided a high level of patient satisfaction.
Patients with baseline scalp psoriasis had more severe disease and were slower to respond initially compared to patients without, but this was no longer significant by week 8, at which point the majority of patients had achieved a PASI response and continued to improve by week The median PSSI score in patients at baseline was 14, at week 8 was 1, and at week 16 was 0. By week 8, There are no formal studies of the anti-TNF chimeric monoclonal antibody infliximab in scalp psoriasis.
Improvement was consistent with the overall PASI responses in all regions. Improvement was defined as a minimum of 1. The regional response rate was highest for the scalp at week 10, compared to other areas examined. However, there have been case reports on the benefit of this biologic agent in recalcitrant scalp psoriasis. Di Cesare et al and Papadavid et al each present two cases of recalcitrant scalp psoriasis that cleared with ustekinumab by week 8 of treatment.
A monoclonal antibody against ILa, ixekizumab, was analyzed in a post hoc analysis of the Phase 2 trial to determine the effect on scalp psoriasis. At week 12, the percentage improvement of PSSI from baseline was By week 20, a PSSI of 0, or clear, was achieved in Secukinumab, another monoclonal antibody against ILa, which was approved for treatment of plaque psoriasis in , currently has a Phase 3b trial in progress for patients with scalp psoriasis.
This week study has a week placebo-controlled period and is comparing secukinumab mg to placebo in a ratio.
Modalities to enhance delivery, such as UVB comb, have been developed and tested. In one trial, 14 subjects were treated with a fiber-optic UVB comb three times weekly for 12 weeks, with an area of scalp reserved as a control site. In this study, the treatment sites showed a mean improvement in the modified PASI score of 3.
Laser and light sources to treat scalp psoriasis are a challenge due to the presence of hair. One study used a nm excimer laser, a UV light source with a blowing device to part the hair for optimal delivery.
Of the patients enrolled, all had failed class 1 topical steroids along with many other topical therapies. Psoriasis, including scalp psoriasis, is a chronic, recurrent inflammatory condition that has a profound impact on patient quality of life. Many patients report distress related to physical appearance as well as itching, scaling, and in some cases, alopecia. The mainstay of treatment is topical therapy, but this can be challenging given the location and hair-bearing skin.
Adherence is an issue and newer topical formulations, such as foams and sprays, help to improve treatment outcomes by improving adherence. In those patients with moderate-to-severe disease who do not respond to topical treatments, systemic therapy needs to be considered. The authors have no other conflicts of interest to disclose. National Center for Biotechnology Information , U.
Journal List Psoriasis Auckl v. Psoriasis Auckl. Published online Mar Kim Blakely 1 and Melinda Gooderham 2. Author information Copyright and License information Disclaimer. This work is published and licensed by Dove Medical Press Limited. The purpose of this study is to assess the long-term safety, tolerability, and effectiveness of secukinumab over ustekinumab for the treatment of patients who have moderate to severe plaque psoriasis.
The purpose of this study is to survey parents or caregivers of children with psoriasis regarding their quality of life with the newly-developed Psoriasis Caregiver Impact Scale PsoriaCIS. The primary purpose of this study is to evaluate the clinical effectiveness of apremilast compared with placebo in children and adolescents ages 6 through 17 years with moderate-to-severe plaque psoriasis.
This research study is being done to find out whether autoimmune mechanisms are associated with the development of atrial fibrillation. The purpose of this study is to develop a psoriasis-specific tool to assess the quality of life of the parents and caregivers of children with psoriasis.
The purpose of this study is to promote patient-centered care by efficiently determining the presence of quality of life issues and their relation to depression and psoriatic arthritis in psoriasis patients.
0コメント